Kansas House Advances Midwives Bill But Debate Continues
The Kansas House on Monday tentatively approved a bill that would provide certified nurse midwives with limited authority to establish independent practices.
Supporters hailed it as a breakthrough in the long-running battle between doctors and advanced practice registered nurses seeking authority to practice independently. But certified nurse midwives, who recently split with APRNs to push for their own independent practice legislation, objected to the bill because it would require them to obtain a separate license from the Kansas Board of Healing Arts, the state agency that regulates the practice of medicine.
During a hearing on the bill, Cathy Gordon, a certified nurse midwife and partner in a company that operates birth centers in Johnson and Wyandotte counties, said requiring midwives to obtain separate licenses from the board of healing arts and the Kansas State Board of Nursing would be unworkable.
“To us it looks like we would be serving two masters,” Gordon said. “No state does it this way.”
In addition, Gordon said, the bill would continue to prohibit midwives from performing a range of women’s health services unless they had a collaborative practice agreement with a supervising physician.
“It significantly restrains our ability to practice,” she said.
But Rep. Dan Hawkins, a Wichita Republican and chairman of the House Health and Human Services Committee, defended the measure as a “reasonable” compromise.
“I believe this is a good compromise,” Hawkins said, noting that the bill would allow certified midwives to perform a core set of obstetric services without a collaborative agreement.
“I believe that we will see certified nurse midwives that will step through that door and will use this to further their business,” he said.
Rep. Barbara Bollier, a Mission Hills Republican and retired anesthesiologist, opposed previous efforts to expand the practice authority of midwives and APRNs. But she said the limited expansion authorized in the bill — House Substitute for Senate Bill 402 — was a compromise she also could support.
“It’s been a long time coming,” Bollier said. “Placing nurse midwives under the board of healing arts is a great first step. And I think we will see further changes ahead for other types of caregivers.”
Certified nurse midwives, APRNs and groups pushing for the licensure of dental therapists have long argued that expanding what mid-level providers can do without supervision from doctors and dentists is a way to expand access to care in rural and underserved areas. But they have been unable to overcome opposition from the state’s doctors and dentists.
Some see Monday’s action as an important breakthrough that could lead to progress on other scope-of-practice bills. They point to the fact that several physician organizations that had opposed previous independent practice proposals supported the midwives bill.
“This wasn’t our first choice, but it was a compromise we supported because we felt that it dealt with the top priorities of both stakeholder groups,” said Rachelle Colombo, a lobbyist for the Kansas Medical Society.
Specifically, Colombo said, while the bill allows certified nurse midwives to independently “manage normal and uncomplicated pregnancies and deliveries,” the dual licensure requirement ensures that the board of healing arts will retain jurisdiction where “there is overlap in the practice of medicine.”
Jim McLean is executive editor of KHI News Service in Topeka, a partner in the Heartland Health Monitor team.